Hundreds of prescribers were identified as questionably prescribing opioids by the Health Department’s watchdog, but one of these prescribers thinks the list itself is questionable.
“I find that somewhat frustrating because we're trying to minimize suffering and manage people's ability to function,” said Dr. George Baylor, physician at Blue Ridge Pain Management.
About 400 prescribers under Medicare Part D were identified as having questionable prescribing patterns for beneficiaries at serious risk of opioid addiction or overdose, according to a recent Health Department (HHS) Office of Inspector General (OIG) report.
Blue Ridge Pain Management, which is located in Virginia, has five prescribers on the list.
“Using the terminology questionable is somewhat unfair, because they're using very limited criteria,” Baylor said. “They're looking at a Medicare population, they're looking at an arbitrary dose number and they're looking at patients who have been on those doses for greater than a year.”
The 400 prescribers identified either ordered "extreme amounts" of opioids or prescribed opioids to Medicare beneficiaries who looked to be doctor shopping, according to the report. The prescribers wrote over 252,000 prescriptions in 2016, costing Medicare $66.5 million.
But Baylor said that as a pain management clinic, it makes sense that Blue Ridge physicians would prescribe higher amounts of opioids. And as for the claim of doctor shopping, he said multiple physicians will appear on their patients’ prescriptions because they all see these patients.
"It's very easy for somebody to be in our practice seeing everybody appropriately and have four different people show up on the PNP, which is what it is. It flags these things, but I think it's a pretty reasonable practice," said Dr. Anthony Dragovich, a physician at Blue Ridge Pain Management.
The HHS OIG provided identification numbers for about 270 of the 400 prescribers identified, and of those provided about one third did work at clinics with more than one prescriber on the questionable list.
The list does not confirm that prescribers were engaging in illegal or abusive practices, according to the HHS OIG, but it said it plans to work with the Center for Medicaid and Medicare Services and law enforcement to follow up with the prescribers identified.
But Dr. Baylor said neither him nor anybody at Blue Ridge had been contacted about the report.
When asked to confirm if the prescribers on the list had been followed up with, and if the explanations given by Blue Ridge had been considered, HHS OIG said in an emailed statement to Circa, “We stand by the report findings identifying prescribers who have patterns far outside the norm and warrant further scrutiny."
“There aren't many specialists that do what we do. It's hard to do what we do. The patients we take care of have significant issues," Dragovich said.
Blue Ridge's doctors said that when a patient comes to the clinic, they try to exhaust alternative methods for pain management before turning to opioids.
“The best success rates we have are in the 70 percent range, which means there's still 30 percent of the people that fall out over that, that your options are you either let them suffer, or they can have opioids," Dragovich said.
And when a patient is prescribed the pain killer, Blue Ridge's doctors said they have a system in place to manage the addiction risks.
"We have a really good prescription monitoring program, which allows us to determine what medication, from what physician, in what quantities and what pharmacy they obtain these medications from and what date that the pharmacy filled that," Baylor said.
Baylor said the physicians at Blue Ridge also utilize the National Association of Boards of Pharmacy prescription monitoring program, which allows them to monitor if their patients have been prescribed any medications in other states.
The only flaw in the program, according to Baylor, is that not all 50 states use it.
“Somebody can cross into North Carolina in a little over an hour from our community and fill a prescription in the state of North Carolina, and unless we request the prescription monitoring program from North Carolina we wouldn't know that," Baylor said.
Blue Ridge's doctors said their patients also must comply with regular and random pill counts and have their urine, blood or saliva tested as part of the addiction risk management.
Marilyn Mocksfield is a patient at Blue Ridge and said she had gone to doctors in the past to try to find a solution to her pain, but it wasn't until she went to Blue Ridge that it became tolerable.
“I started out with pain management with my spine, which was deteriorating and causing great discomfort and getting no relief from any other source," Mocksfield said.
She said the clinic does a lot to manage the medications, and before coming to Blue Ridge her other option for the pain would have been surgery, but she said there was a chance she would have lost her ability to walk and she did not want to take that risk.
And moving forward, both Baylor and Dragovich said they hope to have more cooperation between stakeholders of the opioid epidemic.
“As a physician actually doing this for a living, is I want help from the people who have the data. I would love help from insurers, I would love help from the government, I would love help with them giving us an overview of how our patients are doing," Dragovich said.
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